Health Care in Canada: We Didn't Get it Right Either

It is an interesting time in the United States. As a transplanted Canadian, I have an outsider's view on the tug of war being fought between the Republicans and Democrats over a public health care option. It is a war that puzzles me. Offering a social safety net for all citizens is being viewed by the right as communism. In fact, many Tea Party right wingers would even roll back public education if they could. What about public roads? Or communal sewers? There are basic things that Americans need in order to be able to realize the vision set out by the forefathers: sanitation, food, health, and education. To leave the wealthy to make decisions on these basic amenities for the poor and disadvantaged is paternalistic and follows the English class model that the first American settlers fought so hard to escape. The American model was built on the premise of equal opportunities for everyone. The American dream.

That's not to say, however, that all countries with fully-funded health care have gotten it right either. Canada has had publicly-funded health care since 1957. Under the current model, the funding is shared through provincial and federal income taxes and a payroll tax on large employers. Doctors and hospitals are still private entities but are paid for services and procedures by the government. Canadians never even get to see the bill in most cases and no emergency room in the country has a cashier station.

Over time, the government was criticized by taxpayers for the large amount of money that doctors could make. Basically, if they saw more patients, they made more money- like every other profession in the country. The government chose to address this perceived billing abuse by capping the amount that doctors could make through the plan. The restriction had the unintended consequence of disincentivizing doctors from seeing any patients once they had hit their annual cap (around $200,000 gross). Quite suddenly, many doctors stopped taking on new patients as their practice was already financially full. Fewer students chose medicine as a career because of the income ceiling.

The impact of all of this wasn't felt by us until my daughter was born in 1999. As I called to make a well-baby appointment, a voicemail message informed me that our doctor had left Canada to practice in another country. In our area, not far outside of Toronto, it meant that we were doctorless. No other physicians in the county were taking new patients. All of our medical needs would have to be met through visits to urgent care centers or emergency rooms, both of which required long waits with no appointments. It was a complete but necessary abuse of the emergency medical system that tens of thousands of Canadians had to endure. My annual pap smear, prescription renewals, and other minor issues all had to be carried out in this manner. While we were grateful that we still had access to care, it left us with no continuity of that care. We would see a different doctor each time and, quite often, they were less than impressed about these minor issues.

Canada, like the United States, is in need of a major health care overhaul, but this I know for sure. In my lifetime, not one person in Canada died because they couldn't afford to be treated. And not one Canadian lost their home because they couldn't afford to pay.